MEDICARE: J MEDICAL BRACING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750648770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J MEDICAL BRACING LLC

Provider Business Mailing Address
First Line	:	450 E 96TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-5703
Country	:	US
Telephone Number	:	317-863-0922
Fax Number	:	317-405-9697

Provider Business Practice Location Address
First Line	:	450 E 96TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-5703
Country	:	US
Telephone Number	:	317-863-0922
Fax Number	:	317-405-9697

Authorized Official
Title or Position	:	CEO/MANAGER
Name	:	JENISE LYNN JONES
Credential	:
Telephone Number	:	317-679-4507

Provider Enumeration Date	:	04/15/2012
Last Update Date	:	07/24/2012

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